On July 11, 2016, the Office for Civil Rights (“OCR”) published guidelines for ransomware attack prevention and recovery, including the role HIPAA has in assisting covered entities and business associates to prevent and recover from such attacks, and how HIPAA breach notification processes should be managed in response to a ransomware attack. According to the OCR report, there have been 4,000 daily ransomware attacks since early 2016, up 300% from 2015. Earlier this week a healthcare IT Security Consultant told me the chatter he hears is that the hackers out there are working on stronger, more aggressive, more deadly hacks to unleash, and he fears a hacking storm a brewin’. Time to get serious and batten down the hatches, folks!

The OCR report describes what a ransomware attack is, and explains that maintaining strict HIPAA Security Rule compliance can help prevent the introduction of malware, including ransomware. Some of the required security measures discussed include:

Implementing a security management process, which includes conducting a risk analysis and taking steps to mitigate or remediate identified threats and vulnerabilities;

Implementing processes to guard against and detect malicious software;

Training users on malicious software protection; and

Implementing access controls.

Since ransomware gets into your system and then ties up your data, denying you access to your data (usually through encryption), and then directs you to pay a ransom to the hacker in order to receive a decryption key, maintaining frequent backups and ensuring the ability to recover data from backups is crucial to recovering from a ransomware attack. Again, HIPAA compliance protects entities because the Security Rule requires covered entities and business associates to implement a data backup plan as part of maintaining an overall contingency plan, which includes periodic testing of the plan to be sure it works.

The presence of ransomware – or any malware – is considered a security incident and triggers the need to initiate security incident response and reporting procedures. Based upon an analysis of the investigation results, breach notification may be required. Additionally, if there is an impermissible disclosure of PHI in violation of the privacy rule there is a presumed breach which may trigger notification. Whether or not the presence of ransomware would be a breach under HIPAA Rules is thus fact specific. However, unless the entity demonstrates there is a “…low probability that the PHI has been compromised,” a breach of PHI is presumed to have occurred and the entity must comply with the applicable breach notification provisions.

Once again news reports teach us that the time to have your robust data privacy and security program in place and continually monitored was yesterday!

On June 26 it was reported on DataBreaches.net that 655,000 patient records from three different healthcare databases were up for sale on the dark net. According to reports on the DeepDotWeb, at least one of the hacked entities was using SRS EHR v.9 patient management software. DeepDotWeb also reports that the hacker communicated with them over an encrypted Jabber conversation, and included images from the largest database hack from the hacker’s internal network. The seller/hacker asked the website to add a note to the breached companies: “Next time an adversary comes to you and offers you an opportunity to cover this up and make it go away for a small fee to prevent the leak, take the offer. There is a lot more to come.”

Apparently it was shortly after that a fourth stolen database consisting of a reported 9.3 million individuals records from a health insurer went up for sale. The hacker taking credit for all refers to himself as “The Dark Overlord”. He claims to have contacted the entities to warn them about the vulnerabilities of their systems, and offered to fix or reveal the problems, for an undisclosed amount, which the healthcare organizations declined. In other words, the hacker offered the stolen data back to its owners for an extorted ransom. When the demand was not paid the hacker moved on to Plan B – sell the data on the dark web. The hacker offered the data from the four hacked healthcare organizations for prices ranging from $96,000 to $490,000 in bitcoin.

In the past week two of The Dark Overlord’s targets – Athens Orthopedic Clinic in Georgia and a Missouri group of clinics owned by Dr. Scott Van Ness – have been identified. The hacker accessed electronic medical records of both targets using the credentials of a third-party vendor. Personal information of current and former patients was breached, including names, addresses, social security numbers, dates of birth and telephone numbers, and in some cases diagnoses and partial medical history. Athens Orthopedic Clinic is advising its current and past patients to place a fraud alert on their credit reports with the major credit bureaus. This notice, however, is alleged to have materialized only after events of last weekend, when 500 patients records from Athens Orthopedic Clinic appeared on Pastebin, with a note to their CEO to “pay the [expletive omitted] up.”

Notably, according to reports on Databreaches.net, both entities have acknowledged that the attacker likely got access by an unnamed third party contractor (presumably the EMR vendor). Databreaches.net claims however that neither entity mentioned the ransom demands or that patient data was being dumped in public and was still up for sale on the dark net. Athens Orthopedic Clinic apparently did work to get the information removed from Pastebin, but the other group’s data was still posted as of July 16.

Several lessons- or at least questions- must be in the minds of any healthcare organization as they learn of these events. First is to question of whether your own data security is protected from such attacks, or are you vulnerable as well? How safe is your EMR system? How closely do you audit and monitor the third party vendors you contract with? Second, and something I think every organization should have at least a working framework to use for analysis in the event they find themselves the recipient of a post-breach ransom demand, is, what will your response be in the event you receive such a demand?

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